Axilla brachial plexus

1. UPPER EXTREMITY-2
DR VINIT K ASHOK
ADJUNCT FACULTY

2. BLOOD SUPPLY
• ARTERIAL SUPPLY
• -SUBCLAVIAN
ARTERY(NECK)
• - AXILLARY ARTERY( UPPER
ARM;UPTO LOWER BORDER
OF TERES MAJOR)
• BRACHIAL ARTERY(LOWER
PART OF ARM)
• RADIAL ARTERY( LATERAL)
• ULNAR ARTERY(
MEDIAL),COMMON
INTEROSSEOUS
• PALMAR ARCHES
• DIGITAL

3. VEINS OF UPPER LIMB
• SUPERFICIAL VEINS
- DORSAL VENOUS NETWORK
- CEPHALIC VEIN
- BASILIC VEIN
- AXILLARY VEIN( BASILIC+
BRACHIAL VEIN)
- MEDIAN CUBITAL VEIN
- MEDIAN VEIN OF FOREARM
- DEEP VEINS
- NAMED ACCORDING TO
COMPANIAN ARTERIES
- RADIAL VEIN
- ULNAR VEIN
- BRACHIAL VEIN
- AXILLARY VEIN

4. SURFACE ANATOMY
• ACROMION
• CLAVICLE
• DELTOID ( IM INJECTIONS)
• HUMERUS
• BICEPS MUSCLE
• BICIPTAL GROOVE
• BRACHILA PULSE( BLOOD
PRESSURE)
• TRICEPS
• OLECRNON PROCESS( PT OF THE
ELBOW)
• MEDIAL /LATERAL EPICONDYLES
• TRIANGLE
• CUBITAL FOSSA
• MEDIAN CUBITAL VEIN- IV
• CEPHALIC VEIN
• ULNA
• RADIUS
• STYLOID PROCESS
• RADIAL ARTERY( PULSE)
• ULNAR ARTERY
• ANATOMICAL SNUFF BOX
• THENAR EMINENC
• HYPOTHENAR EMINENCE
• CARPAL TUNNEL

9. CUBITAL FOSSA

10. CUBITAL FOSSA

11. STYLOID PROCESS

12. ANATOMICAL SNUFF BOX

13. AXILLA( ARMPIT)
• PYRAMIDAL SPACE BETWEEN THE
UPPER LATERAL CHEST AND THE
INNERSIDE OF THE ARM
• BOUNDARIES
-APEX –( BETWEEN THE
CLAVICLE,SCAPULA AND 1ST RIB)
-BASE-(AXILLARY FASCIA)
-ANTERIOR ( PECTORALIS MAJOR AND
MINOR MUSCLES)
-POSTERIOR(
SUBSCAPULARIS,LATISSIMUS
DORSI AND TERES MAJOR)
MEDIAL- ( FIRST 4 RIBS AND
SERRATUS ANTERIOR MUSCLE)
LATERAL-( BICEPETAL GROOVE OF
THE HUMERUS)
• CONTENTS
-AXILLARY LYMPH NODES
-AXILLARY ARTERY /VEIN
-BRACHIAL PLEXUS

14. BRACHIAL PLEXUS
• PLEXUS- IS A NETWORK OF
NERVES
• BRACHIAL PLEXUS-
• FOUND IN THE NECK AND AXILLA
• FORMED BY VENTRAL RAMI OF C5-
C8 AND T1 ( THERE MAY BE
CONTRIBUTIONS FROM C4, T2)
• GIVES RISE TO NERVES THAT
SUPPLY THE UPPER LIMB
• FORMATION
• ROOTS- C5-C8 AND TI( VENTRAL
RAMI)
• TRUNKS-UPPER , MIDDLE, LOWER
• DIVISONS-ANTERIOR/POSTERIOR
• CORDS-
MEDIAL/LATERAL/POSTERIOR
• ROOTS FORMATION OF TRUNKS
• C5
• C6
• C7
• C8
• T1
UPPER
MIDDLE
LOWER
FORMED IN
THE NECK

15. DIVISIONS AND CORDS OF
BRACHIAL PLEXUS
• TRUNKS DIVISIONS CORDS
• UPPER TRUNK
• MIDDLE TRUNK
• LOWER TRUNK
PINK-
ANTERIOR
DIVISION
BLUE -
POSTERIOR
DIVISION
LATERAL CORD-ANTERIOR
DIVISIONS OF UPPER AND
MIDDLE TRUNK
POSTERIOR CORD-
POSTERIOR DIVISIONS OF ALL
TRUNKS
MEDIAL CORD-ANTERIOR
DIVISION OF LOWER TRUNK
CORDS ARE NAMED
ACCORDING TO THEIR
RELATIVE POSITIONS TO THE
AXILLARY ARTERY

16. BRACHIAL PLEXUS

18. NERVES ARISING FROM THE
CORDS
• MEDIAL CORD
1. MEDIAL CUTANEOUS NERVE OF ARM- CUTANEOUS SUPPLY
TO SKIN
2. MEDIAL CUTANEOUS NERVE OF FOREARM-CUTANEOUS
SUPPLY TO THE SKIN
3. MEDIAL ROOT OF MEDIAL NERVE- JOINS WITH LATERAL
ROOT TO FORM MEDIAN NERVE
4. ULNAR NERVE
5. MEDIAL PECTORAL NERVE
• LATERAL CORD
1. LATERAL ROOT OF MEDIAN NERVE
2. MUSCULOCUTANEOUS NERVE
3. LATERAL PECTORAL NERVE

19. NERVES FROM THE POSTERIOR
CORD
• 1. UPPER SUBSCAPULAR NERVE
• 2.LOWER SUBSCAPULAR NERVE
• 3.THORACODORSAL NERVE
• 4. RADIAL NERVE
• 5. AXILLARY NERVE

20. IMPORTANT NERVES AND AREA
OF SUPPLY
• 1. MEDIAN NERVE( FORMED FROM BOTH MEDIAL AND LATERAL
CORD)-
• A) SUPPLIES ALL THE FLEXORS OF THE FOREARM( EXCEPT FLEXOR
CARPI ULNARIS AND MEDIAL HALF OF FDP)
• B) INTRINSIC MUSCLES IN THE LATERAL PALM INCLUDING THENAR
EMINENCE)
• 2. ULNAR NERVE
• A) SUPPLIES THE MEDIAL HALF OF FDP AND THE FLEXOR CARPI
ULNARIS
• B) SUPPLIES MOST OF THE INTRINSIC MUSCLES OF THE HAND
INCLUDING THE HYPOTHENAR EMINENCE, AND SKIN ON THE
MEDIAL SIDE OF THE HAND
• CLINICAL APPLICATION
• *INJURY TO MEDIAN NERVE-” APE HAND”
• INJURY TO ULNAR NERVE-” CLAW HAND”

21. INPORTANT NERVES AND THEIR
AREA OF SUPPLY
• MUSCULOCUTANEOUS NERVE
A) SUPPLIES THE BICEPS, CORACOBRACHIALIS AND BRACHIALIS
AXILLARY NERVE
- SUPPLIES THE DELTOID AND TERES MINOR MUSCLE
- SUPPLIES THE SHOULDER JOINT
RADIAL NERVE
- SUPPLIES THE TRICEPS
- SUPPLIES THE BRACHIORADIALIS
- SUPPLIES MOST OF THE EXTENSORS OF THE FOREARM
- * INJURY RESULTS IN “ WRIST DROP”

22. CARPAL TUNNEL
• TUNNEL FORMED BETWEEN THE CONCAVITY OF THE CARPAL
BONES AND A LIGAMENT THAT COVERS THIS( FLEXOR
RETINACULAM)
• TENDONS OF THE FLEXORS PASS THROUGH
• MEDIAN NERVE ALSO PASSES THROUGH
• CROWDED TUNNEL
CARPAL TUNNEL SYNDROME
- CAUSED DUE TO COMPRESSION OF THE NERVE IN THE TUNNEL
- CAUSES-
- 1. SWELLING OF THE TEDONS( OVERUSE)
- 2. PREGNANCY( EDEMA)
- 3. ARTHRITIS
SYMPTOMS- TINGLING OR NUMBNESS-LATERAL PART OF HAND,
WEAKNESS IN THUMB MOVEMENT
TREATMENT- REST, SPLINTING,ANTI-INFLAMMATORY DRUGS, SURGERY

23. CUBITAL FOSSA
• TRIANGULAR DEPRESSION ON
THE ANTERIOR ASPECT OF
ELBOW
BOUNDARIES
-BASE- LINE DRAWN BETWEEN THE
EPICONDYLES OF THE HUMERUS
LATERAL BOUNDARY-
BRACHIORADIALIS
MEDIAL BOUNDARY- PRONATOR
TERES
APEX- WHERE THE MEDIAL AND
LATREAL BOUNDARY MEET
CONTENTS
1. MEDIAL CUBITAL VEIN
2. BRACHIAL ARTERY
3. TENDON OF THE BICEPS

24. CUTANEOUS INNERVATION
OF HAND( ANTERIORLY)
LATREAL 31/2 FINGERS
AND LATERAL PALM –
MEDIAN NERVE
MEDIAL 11/2 FINGERS AND
MEDIAL PALM- ULNAR
NERVE

25. CUTANEOUS NERVE SUPPLY HAND (
POSTERIORLY)
MEDIAL 11/2 FINGERS AND HAND- ULNAR
NERVE
TIPS OF FINGERS LATERAL 31/2
FINGERS- MEDIAN NERVE
REST OF LATERAL 31/2 FINGERS AND
HAND - RADIAL NERVE